SIR 2024
Portal Hypertension
Zeiad Hussain, M.D
Interventional Radiology Attending
University Hospital, University of South Alabama
Disclosure information not submitted.
Lucas F. Sheridan, DO (he/him/his)
Radiology Resident
University of South Alabama
Financial relationships: Full list of relationships is listed on the CME information page.
Charles R. Diard, MD (he/him/his)
Radiology Resident
University of South Alabama
Financial relationships: Full list of relationships is listed on the CME information page.
Retrospective review of prospectively maintained clinical, procedural and demographic data of patients underwent SAE for the management of HE in our institute between January 2021 to September 2023. All procedures were performed by one interventionist with 4-year experience in the portosystemic embolization for the management of HE. Technical success was defined as successful embolization of 70% of the splenic parenchyma while maintaining flow to the upper 1/3 of the spleen. Clinical success was defined as improvement in HE symptoms. All patients underwent 1 and 6 month follow-up in IR clinic with CT scan of the abdomen performed on first visit.
Results:
Three adult patients (2 females) underwent SAE utilizing bland particles in two patients and a combination of particles and proximal SAE in 1 patient. One patient had complete chronic occlusion of the portal vein, with a large splenogastrorenal shunt being the only splenic and mesenteric veins outflow. Two patients had cirrhosis with massive splenomegaly and chronic low platelet counts, in addition to moderate to severe chronic left upper quadrant (LUQ) pain in one patient. Technical success was achieved in all 3 patients, with residual perfusion in only 30% of the splenic parenchyma. At 1- and 6-month follow-up all patients reported significant subjective improvement in HE symptoms. One patient with splenomegaly reported a prolonged LUQ pain for 8 to 10 weeks. Paradoxically, the patient who initially presented with severe constant LUQ pain, reported significant improvement in her pain.
Conclusion:
All three patients had subjective and objective improvement of HE symptoms following SAE. While it is not without a substantial risk, such as prolonged abdominal pain and splenic abscess, SAE may represent an alternative to traditional portosystemic shunt embolization in patients who fail medical treatment for HE, and in whom shunt embolization is not feasible due to anatomical and clinical factors. Further research is needed to confirm short- and long-term outcomes and establish clear guidelines to refine patient selection.